Maternal obesity

Previous studies have found that adverse effects of maternal employment on child obesity are limited to mothers with higher education and earnings. Explanations for this have centered on differences between the childhood nutritional and exercise environments provided by non-parental caregivers versus by the mothers.

For the 57th Nestlé Pediatric Nutrition Workshop, which took place in May
2005 at Half Moon Bay, San Francisco, the topic ‘Primary Prevention by
Nutrition Intervention in Infancy and Childhood’ was chosen. Early nutrition
seems to be involved in the mechanism of control, especially taking into
account the role of protein and long-chain polyunsaturated fatty acids (LCPUFAs).
It seems that the new generation of infant formulas already takes
those findings into consideration.
We would like to thank the two chairmen, Prof. Hugh Sampson and Prof.

The Working Group believes that, in addition to making a meaningful contribution to
the diet, foods marketed to children should also be those with minimal quantities of nutrients
that could have a negative impact on health and weight. Nutrition Principle B therefore
proposes targets for limiting the amount of sodium, saturated fat, trans fat, and added sugars.
In selecting the four specific nutrients, the Working Group is again drawing from
recommendations from the 2010 DGA.

The government aims for 100% enrollment as part of the MDG targets for 2015, with
girls' enrollment share being 50%. Various obstacles to achieving this goal exist, such as
lack of school facilities, in particular girls' schools in rural areas. The problem is even
greater for girls' secondary schools, which are very few and scattered. Insecurity,
combined with distance and lack of transport, prevents especially girls from accessing
school facilities.

Despite the standard definitions noted above, accurate identification of the causes of
maternal deaths is not always possible. It can be a challenge for medical certifiers to attribute
correctly cause of death to direct or indirect maternal causes, or to accidental or incidental
events, particularly in settings where deliveries mostly occur at home. While several countries
apply the ICD-10 in civil registration systems, the identification and classification of causes of
death during pregnancy, childbirth and the puerperium remain inconsistent across countries.

In 2012, WHO published the Application of ICD-10 to deaths during pregnancy, childbirth
and the puerperium: ICD Maternal Mortality (ICD-MM), to guide countries to reduce errors in
coding maternal deaths and to improve the attribution of cause of maternal death (10). The
ICD-MM is to be used together with the three ICD-10 volumes. For example, the ICD-MM
clarifies that the coding of maternal deaths among HIV-positive women may be due to:
Obstetric causes: such as haemorrhage or hypertensive disorders in pregnancy – these should
be identified as direct maternal deaths.

These studies are diverse, depending on the definition of maternal mortality used, the
sources considered (death certificates, other vital event certificates, medical records,
questionnaires or autopsy reports) and the way maternal deaths are identified (record
linkage or assessment from experts). In addition, the system of reporting causes of death to
a civil registry differs from one country to another, depending on the death certificate forms,
the type of certifiers and the coding practice.

In recent years a number of factors have had a signiﬁcant impact on
the capacity of maternity services and midwives to deliver quality care.
Many more women and families are recognised as having complex
physical and social needs including women and families living in
poverty; migrant women who do not speak English as a ﬁrst language;
teenage mothers; women who are misusing drugs and alcohol; women
who are obese and those who have long-term conditions such as
diabetes. In addition the average age of ﬁrst birth is now 29.4 years
compared with 28.

Parents and children need a framework for care which provides
continuity from pre-pregnancy, through pregnancy and childbirth, to
the early years of life. A comprehensive approach to early life is needed
which builds on existing programmes to ensure our children get the
best start in life8. Midwives have a key role in ensuring that their
contribution integrates with the roles of other professionals and
agencies working in collaboration with maternity services.

It has been documented, for example, that high maternal pre-pregnancy weight and excessive
weight gain during pregnancy are often associated with adverse pregnancy outcomes,
including greater risks of gestational diabetes, childbirth complications, caesarean sections,
hypertension and pre-eclampsia, and post-partum obesity. Women with severe (morbid)
obesity are more likely to experience even poorer outcomes such as stillbirths or neonatal
deaths.

Nutrient deficiencies were reported in infants born to women who underwent procedures that
resulted in malabsorption, as well as women who did not take prenatal vitamins or had difficulty
with their own nutrition (i.e., from chronic vomiting). Literature suggests that gastric bypass and
laparoscopic adjustable band procedures confer only minimal, if any, increased risk of nutritional
or congenital problems if supplemental vitamins are taken and maternal nutrition is otherwise
adequate. Biliopancreatic diversion has an appreciable risk for nutritional problems in some
patients.

Weight loss procedures are being performed more frequently to treat morbid obesity, with a
six-fold increase over a recent 7-year time span; almost half of patients are women of
reproductive age. The level of evidence on fertility, contraception, and pregnancy outcomes is
limited primarily to case series and case reports. The evidence suggests that fertility improves
after bariatric surgical procedures; however, data are too sparse to reach definite conclusions
about the degree of improvement in fertility that is achieved.